Preoperative cardiopulmonary exercise testing: physiological basis and investigation.

Abstract

For over 20 years cardiopulmonary exercise testing (CPET) has been used in the perioperative setting. Over 30,000 tests are performed annually by an increasing number of centres in the UK. Each test produces a large volume of detailed data on the integrative exercise responses of various body systems. Interpretation of CPET data requires thorough understanding of basic exercise physiology and its clinical application. CPET data are incorporated into a global preoperative assessment to provide a personalized risk estimate of perioperative complications and death. Individualized risk assessment can be discussed within the multidisciplinary team and during patient encounters to inform best interests decisions. Such decisions also help in optimizing the use of resources in an increasingly pressured healthcare setting. As CPET services expand we explore how it can contribute to managing peri-operative risk and planning individualized care.